2023 EmblemHealth VIP Dual (HMO SNP) | EmblemHealth

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EmblemHealth VIP Dual (HMO D-SNP)

This is a special needs plan (HMO D-SNP) for people enrolled in Medicare and who have full New York State Medicaid. You may pay as little as $0 each month for this plan based on your Low-Income Subsidy (LIS) level. You pay $0 for covered services in this plan.

You will also get benefits Medicare does not cover, like comprehensive dental, hearing aid allowance, eyewear allowance, $0 for 10 additional acupuncture visits, a SilverSneakers® membership, and $60 for over-the-counter (OTC) items monthly including healthy food items and produce.


Available in the following counties: Suffolk


Provider Network: VIP Bold


Your level of Extra Help Premium
0% $38.90
25% $29.20
50% $19.40
75% $9.70
100% $0.00

Plan Highlights

If you have questions, please call 800-859-4880 (TTY: 711) daily from 8 am to 8 pm.

Benefit Summary

Type of Care Copay
Primary care doctor visit: $0
Specialist doctor visit: $0
Preventive care (services that keep you healthy): $0
Urgently needed services: $0
Emergency room: $0
Inpatient hospital coverage: $0
Lab services: $0
X-rays: $0
Type of Care Copay
Foot care: $0
Dental services (no annual dollar limit): Comprehensive and preventive
Hearing aids: $1500 every 3 years
Routine eyewear: $500 every 2 years
24-Hour Nurse Line: Yes
SilverSneakers®: Yes
Prescription drugs: Yes

Drug Coverage

Having the medicines you need is an important part of staying healthy, which is why we take our pharmacy offerings very seriously. We strive to help you make sure you can afford the medicines you take. Our formulary gives you access to thousands of them, and our pharmacy network is large enough to provide the choices you need—close to home.

(The amount you pay before your plan starts to pay)

You Pay
$0-$4,660 – 30-Day Supply 

You Pay
Over $4,660

You Pay
Over $7,400

You Pay
Annual Deductible




Tier 1 Preferred Generic Drugs

Tier 2 Generic Drugs

$0 - $4.15

Tier 3 Preferred Brand Drugs*

Tier 4 Non-Preferred Drugs

Tier 5 Specialty  Drugs

$0 - $10.35*

Tier 6 Select Care Drugs


Drug Cost Calculator

Use our Cost Calculator tool to estimate your prescription drug costs. Enter the prescription drugs you take and we'll show you your monthly drug costs.


Plan Documents

Health Insurance Plan of Greater New York (HIP) is an HMO/HMO D-SNP plan with a Medicare contract and a contract with the New York State Department of Health. Enrollment in HIP depends on contract renewal. HIP is an EmblemHealth company.

SilverSneakers and the SilverSneakers shoe logotype are registered trademarks of Tivity Health, Inc. © 2022 Tivity Health, Inc. All rights reserved. All rights reserved. Teladoc and related marks are trademarks of Teladoc Health, Inc. and are used by EmblemHealth with permission.

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Last Update 10/01/2022